Healthcare Provider Details

I. General information

NPI: 1811290810
Provider Name (Legal Business Name): VEERA VENKATA S BABU PATURI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E ASH ST 1
PERRY FL
32347-2029
US

IV. Provider business mailing address

315 E ASH ST 1
PERRY FL
32347-2029
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-3278
  • Fax:
Mailing address:
  • Phone: 850-584-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME123024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: